July 31, 2018
SVS Publishes New Guidelines for Follow-Up Imaging After Vascular Procedures
July 31, 2018—The Society for Vascular Surgery (SVS) announced the publication of new clinical practice guidelines on follow-up imaging after vascular arterial surgery. The guidelines were published by R. Eugene Zierler, MD, et al in the Journal of Vascular Surgery (JVS; 2018;68:256–284). The document is also available online on the SVS Clinical Guidelines.
The guideline writing group's main focus was to determine what kind of imaging would be most appropriate and, importantly, how often it should be done. When possible, issues involving diagnostic criteria and thresholds for reintervention were also addressed.
According to SVS, the guidelines' six sections cover carotid artery procedures, thoracic and abdominal aortic repairs, mesenteric and renal artery repairs, and lower-extremity arterial revascularization. The recommendations emphasize vascular laboratory testing and vascular imaging for both open and endovascular interventions. Testing should be performed by qualified personnel using appropriate instrumentation, as demonstrated by individual credentialing and facility accreditation, advised the guidelines.
Dr. Zierler, who led the guideline writing group, commented in the SVS announcement, “The overall aim is to provide the best outcome from the initial procedure. All arterial procedures have modes of failure." He added, "To make the arterial intervention as durable as possible, we have to understand these modes, how to detect them, and when to reintervene.”
The society advised that unlike other SVS clinical practice guidelines, none of the recommendations could be based on high-quality evidence (ie, Grade A) but that SVS leadership is committed to the expansion of the evidence base related to follow-up.
Dr. Zierler stated, “Our group’s review of the available evidence clearly shows a need for more clinical research on testing methods, surveillance protocols, indications for reintervention and outcomes. Evidence is somewhat scarce for many of the endovascular techniques because they change so quickly, unlike the more established open procedures. Endovascular procedures are developing rapidly and devices are changing frequently. The life cycle of a certain device or intervention may be quite short.”
According to Dr. Zierler, vascular surgeons must create a follow-up plan for each patient that is most likely to provide the best possible outcome while minimizing costs and risks.
“These guidelines should serve as a starting point for creating that plan," said Dr. Zierler. "We decided early in the development of these guidelines that our overriding philosophy would be to err on the side of caution. The negligible risk and relatively low cost of ultrasound make this approach feasible, and follow-up intervals can be extended if new evidence indicates that it is safe. We want to be cautious until we know with certainty what the best practices really are.” He added that he hopes this guideline can be updated in 3 to 5 years to highlight changes in the recommendations that result from new and better clinical evidence.